The concepts of Telemedicine services could be applied in different ways.
Those are:
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- Patient – Specialist services
- Doctor – specialist services
- Specialist – Specialist Services
- Medical Education between two locations [CME]
- Making virtual classrooms to all the places where we select.
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| The basic idea is to make the specialist services available at a place where we wanted to establish a link. It will make the area virtually availability of the prominent person/specialist to the remote area without being traveling. Spending his time at one place could become virtually available to all those established centers. |
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| Definitions of Telemedicine: |
| The use of medical information exchanged from one site to another using electronic communications for the health and education of patients or providers and to improve patient care. |
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| The investigation, monitoring, and management of patients and the education of patients and staff using systems which allow ready access to expert advice and patient information, no matter where the patient or the relevant information is located. The three main dimensions of telemedicine are health service, telecommunications and medical computer technology. |
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| Telemedicine is the use of electronic information and communications technologies to provide and support health care when distance separates the participants. |
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| The provision of health care services from a distance using audio, video and computer technology. Traditionally uses videoconferencing to diagnose an illness and provide medical treatment. Also used to view or teach surgical procedures. |
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| The delivery of health care services between geographically separated individuals, using telecommunication systems e.g. video conferencing. |
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| The availability of reliable, high bandwidth nationwide networks promise to remove the constraints of geographical locations in many professions. One example that has been investigated is in the area of medicine, whereby the use of such networks allows medical information and expertise to be shared across the country. |
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| The Mobile VSAT Video Conferencing Van at MANAGE liberates the Video Conferencing Services from the fixed conference halls in cities and towns to the rural communities- the farmers in their own environment. The mobile VSAT Van is a mobile satellite terminal which can be used for voice, fax, data, video and Internet application. Constructed on a DCM Toyota Qualis vehicle it is equipped with air-conditioning equipment, and uninterrupted power supply. The data is up-linked to satellite through a motorized antenna |
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| About the Technology and how it has been working: |
- Transmission of Patient data for e.g.: ECG, X-ray, CT scan, MRI, Echocardiography, Angiograms over:
- Simple telephone lines
- ISDN (Integrated Services Digital Network)
- (VSAT Based)
- Broad band / High speed Internet
- The remote centers are linked to Specialty Hub (Narayana Hrudayalaya) on one of the above mentioned transmission lines.
- The remote centers have equipments such as Electro Cardio Graph (ECG) connected to them to record and transmit them to the server placed in the hub.
- The super specialists report based on the received information to advise the course of action to be taken.
- In case of a any Cardiac Emergencies (heart attack, stroke) treatment advise can be given to the doctor in the remote end (i.e. Thrombolyse or medication) from the hub.
- Out patient consultation is provided based on the transmitted X-rays, Angiograms, CT Scan images and MRI images.
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| NH concepts: There are three types of Telemedicine services available today from Narayana Hrudayalaya Telemedicine viz. |
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| Telemedicine Proposal for TTECG (Trans Telephonic Electrocardiograph): |
| Narayana Hrudayalaya and Asia Heart Foundation have implemented many Telemedicine projects in some of the most remote and rural places in the Indian sub-continent with an objective evidence of benefits i.e., more than 7841 lives have been saved and more than 20,152 online specialist consultation have been provided over the past 48 months. |
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There are three different concepts used in Narayana Hrudayalaya and Asia Heart Foundation Telemedicine for providing the specialist health care services across India and abroad.
- Trans Telephonic Electrograph – Transfer of ECGs from General physicians
- Teleconsultation – Virtual specialist consultation with patient data transfer
- Coronary Care Units – Treating cardiac patients by General Physicians who are trained by Narayana Hrudayalaya
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| 1. Trans Telephonic ECG services of Narayana Hrudayalaya: |
| Another innovative aspect of Narayana Hrudayalaya Telemedicine is providing cardiac support to all General practitioners is the use of TTECG. The ECG device is provided to any medical professional where there is no cardiologist support but the report can be received using a computer and a normal telephone line. This can also be supported through Internet services and any IP network. |
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| The entire process of receiving and sending the ECG will take about 10-15 minutes. |
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| This facility could help the cardiac patient population without traveling to any other location for a cardiologist services. |
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| 2. Family Physicians ECG Network: |
| The Computer compatible ECG devices are given to the General Practitioners or any Nursing Homes where they do not have cardiologist to interpret the ECGs. |
Narayana Hrudayalaya has introduced the new program so as to provide the cardiologist services whereby the ECG graph is transmitted through:
- Normal Telephone Lines
- Internet
- By any standard IP based network
Requirements at GPs end:
- One PIV computer or a Laptop with serial port support & Modem
- One ECG device (device will be provided by SN Informatics)
- A telephone Line or Internet support
- Normal DeskJet Printer & UPS
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| Total Cost Involved: Computer Set Total Rs.30000/- and ECG Device Cost Rs.12500/- |
Advantages:
- Accessing the cardiologist services from NH
- Time taken for ECG report may be within 20 mints
- Medication support in case of any complications
- The GPs communication support with the cardiologists in case of emergency
- Protecting the heart patients from cardiac emergencies
- Pre operative protection for all patients
- GP can always get the cardiac support from a distance at an affordable investments
- Services are given free of cost
- Services are given 24 hrs 365 days
- No high cost involvement in transmission
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| 3.Telemedicine – Teleconsultation services: |
| This is supported for round the clock (24X 7) 365 days to access Specialist services from Narayana Hrudayalaya Telemedicine from any remote telemedicine centers. |
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| 4.Coronary Care Services |
| The support at the district and semi urban areas – expertise will be provided by NH technical, administrative and clinical services. This is another potential and highly required services to provide at the district level or below where the cardiac services are supported by the general practitioners who are trained by Narayana Hrudayalaya. |
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Technical Requirements
- 1. The communication support is:
- ISDN – Integrated Services Digital Network- Minimum of 2 Lines 128 kbpsx2
- VSAT – Very Small Aperture Terminal – Bandwidth of 384 kbps
- Internet Broadband with – 512 kbps bandwidth (dedicated)
- Room size: 20x18 or 15x12 feet size room with a Couch is required for Teleconsultation cum video conferencing purpose.
- Video Conferencing System – with 256 ISDN or IP based support
- UPS (Uninterrupted power supply) 1 KV online with Air conditioned support
- 29 “ Television Flat”
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